甲状腺亢进性心脏病治疗的进展

Advances in the Treatment of Hyperthyroid Heart Disease

摘要: 甲状腺功能亢进性心脏病(Hyperthyroid heart disease, HHD)是指过量的甲状腺激素对心脏的直接毒性作用，或通过儿茶酚胺的间接影响，引起的心脏结构和功能异常，常见症状包括心悸、心律失常、心力衰竭等。流行病学数据显示，约10%~20%的甲状腺功能亢进(甲亢)患者可能进展为HHD，其中未规范治疗或病情迁延未控者风险显著增高。值得注意的是，中老年人群(>50岁)的发病率较年轻群体高3~5倍，这可能与其常合并存在的基础心血管疾病密切相关。HHD的治疗策略强调甲状腺功能亢进的控制与心血管并发症的综合管理。在甲状腺功能亢进治疗方面，及时应用抗甲状腺药物(ATD)、放射性碘及手术治疗以恢复甲状腺正常功能；针对心脏损害，则需要根据具体的临床表现采取个体化的抗心律失常及抗心衰等治疗。本文系统综述了甲亢的控制、β受体阻滞剂、钙通道调节剂等关键治疗药物的作用机制及临床应用，旨在为临床治疗及未来的研究提供参考及方向。

Abstract: Hyperthyroid heart disease (HHD) refers to structural and functional abnormalities of the heart caused by the direct toxic effects of excessive thyroid hormones or indirect influences via catecholamines. Common symptoms include palpitations, arrhythmias, and heart failure. Epidemiological data indicate that approximately 10%~20% of patients with hyperthyroidism may progress to HHD, with significantly higher risks observed in those who have not received standardized treatment or have prolonged uncontrolled conditions. Notably, the incidence of HHD in middle-aged and elderly populations (>50 years) is 3~5 times higher than in younger groups, which may be closely related to their frequently coexisting underlying cardiovascular diseases. The treatment strategy for HHD emphasizes both the control of hyperthyroidism and the comprehensive management of cardiovascular complications. For hyperthyroidism, timely application of antithyroid drugs (ATDs), radioactive iodine therapy, and surgical intervention are employed to restore normal thyroid function. For cardiac damage, individualized treatments such as antiarrhythmic and anti-heart failure therapies are administered based on specific clinical manifestations. This article systematically reviews the mechanisms and clinical applications of key therapeutic agents, including hyperthyroidism control medications, β-blockers, and calcium channel modulators, aiming to provide references and directions for clinical treatment and future research.